God am I bloated. I feel sick. I hate hormones. Times like this make me want to try Acutrim or something. Not overdoing it, but just as the package says. I've been exercising and eating right, but it's right after my period and sometimes I get this weird hormone rush. I feel all irritated, and today my jeans that fit fine yesterday don't fit at all. I know it'll go away, but it's too annoying. Do you know of anything for these times of the month? I'm seeing my boyfriend from another school over Thanksgiving and I've been working out to be healthy, and I am, but tonight I feel so bloated and miserable. Help...

Signed,
Water logged

Dear Water logged,

Ahh, the joys of womanhood! Many women experience the bloating and feelings of "sickness" that you describe before, during, and/or after their periods. These may be symptoms of premenstrual syndrome (PMS).

Once a mythological malaise, PMS is now recognized by the medical community as a real nuisance to many women. While the exact cause of PMS is still unknown, the symptoms are probably a result of changes in hormone levels related to menstrual periods. Each affected woman experiences a unique set of symptoms, which often get more regular and severe for women in their late 20s through their 30s. These may include:

swelling, increased sensitivity, and soreness of the breasts

diarrhea or constipation

exaggerated mood swings

increased lethargy/tiredness

depression and/or anxiety

feelings of guilt, insecurity, and/or low self-esteem

sleep changes (more/less sleep)

clumsiness and forgetfulness

food cravings (sugar, fat, and salt cravings are common)

acne outbreaks

joint or muscle pain (low back pain is common)

Instead of waiting for scientists to find a silver bullet, you can take matters into your own hands. Here are a few self-management suggestions to consider during these uncomfortable times:

Keep your intake of salt, sugar, alcohol, and caffeine in check. Sodium contributes to water retention (bloating), and caffeine, alcohol, and sugar can add to mood and sleep problems.

Eat a diet rich in vitamin B6, calcium, magnesium, and vitamin E. Check out Choosemyplate.gov to learn about what types of foods might help you get the right balance of vitamins and minerals you need. You might also consider a multi-vitamin made specifically for women.

Stay away from diuretics. Most diuretics deplete the body of potassium, an essential mineral.

Keep physically active. It's great that you've been working out regularly because the sweating that comes along with vigorous exercise may help relieve some of your bloating. Also, exercise may help elevate mood and reduce tiredness.

Use heating pads for cramps. This can calm cramping by relaxing the belly and uterus.

Try taking non-steroidal anti-inflammatory drugs (NSAIDs) as directed. Health care providers recommend ibuprofen and naproxen sodium to alleviate some of the symptoms related to PMS. You may be tempted to pop more of these pills than directed, but too much of a good thing may lead to more serious problems.

It might be useful to notice and jot down your symptoms and self-management attempts in a diary over the course of two to four months. What's the pattern of your menstrual cycle like? Is it regular? What days of the month do you feel the worse? On those days, what specific symptoms do you have, and how severe are they? What's worked to bring relief, if anything? This process of observation and documentation is called self-monitoring. Through self-monitoring, you'll notice patterns in your symptoms while seeing what self-management tactics work for you.

If, after you self-monitor and try self-management for several months, you still find little or no relief from major PMS symptoms, you may be living with premenstrual dysphoric disorder (PMDD) or have underlying medical issues. If you're concerned that this might be an issue for you, it's a good idea to visit to a health care provider or gynecologist. If you're a Columbia student, you can make an appointment by contacting Medical Services (Morningside) or the Student Health Service (CUMC). It'd be a great idea to bring your self-monitoring diary to the appointment; your provider can use it to find patterns and suggest effective treatment strategies.

PMS is a curious thing. Some women notice PMS symptoms and others don't. For those who do, it can be challenging to predict and manage symptoms. Women who have symptoms often find it helpful to self-monitor with a diary, and, fortunately, they usually find relief through self-management.

Good luck and be well.

P.S.:

Sit down in a calm, quiet place. Let your eyelids close and take a sloooooooow, deep breath. Relax your body and feel the breath fill your stomach. (Your stomach should puff out when you take the breath.) Hold it in for three seconds as you keep your body relaxed. Then, sloooooooowly release the breath. As you release the breath, feel some tension melt away from your body. Repeat this five or more times. You should feel much more relaxed after this.